Eye Inflammation

Question 1

What is the clinical presentation of episcleritis?

Answer 1

segmental eye redness, discomfort, no vision loss, pink color of the sclera

Question 2

What is the population that episcleritis is more present in?

Answer 2

women

Question 3

What is the causation of episcleritis?

Answer 3

connective tissue or vascular disease
often occurs alone in episcleritis

Question 4

What is the treatment of episcleritis?

Answer 4

often resolves spontaneously, may improve with topical NSAIDs or artificial tears

Question 5

What is the clinical presentation of scleritis?

Answer 5

overlying episcleritis, blue hue, painful SEVERE boring eye pain, worsens with eye movement, photophobia, vision loss

Question 6

What is the most common population of scleritis?

Answer 6

women

Question 7

What is the causation of scleritis?

Answer 7

Same as episcleritis with vascular disease; often occurs with systemic autoimmune diseases and infections

Question 8

How can you diagnose scleritis?

Answer 8

labs and imaging!

Question 9

What is the treatment of scleritis?

Answer 9

considered an EMERGENCY, refer to opthalmology
systemic NSAIDS, topical steroids
if no response to above, systemic steroids, subjunctival steroids, immune modulators

Question 10

What is the clinical presentation of anterior blepharitis?

Answer 10

crusting, scaling, erythema of lid margins, “red-rimmed”, eyelashes, irritated, burning, itching

Question 11

What is the cause of anterior blepharitis?

Answer 11

ulcerative from staph infection or inflammation of oil glands

Question 12

What is the treatment of anterior blepharitis?

Answer 12

eyelid hygiene - massage, baby shampoo, warm compress
if constant issue; antibiotic eye ointment – bacitracin or erythromycin

Question 13

What is the clinical presentation of posterior blepharitis?

Answer 13

spider veins in the eyelid, inflamed meibomian glands, lid margin rolled inward, tear film frothy or greasy

Question 14

What is the causation of posterior blepharitis?

Answer 14

bacterial infection (staph), primary glandular dysfunction, ASS W/ ACNE ROASACEA

Question 15

What is the treatment of posterior blepharitis?

Answer 15

warm compress and gland expression
if conjunctiva/cornea are inflamed,
long term low dose oral abx:
tetracycline, doxycycline, minocycline, erythromycin, azithromycin

short term topical corticosteroids: prednisolone

topical abx: ciprofloxacin

Question 16

What is the clinical presentation of internal hordeolum?

Answer 16

localized red, swollen, acutely tender, PAINFUL area on upper/lower lid ‘ points onto conjunctival surface

Question 17

What is the causation of internal hordeolum?

Answer 17

acute = staph aureus, blockage/infection of Zeis (sebaceous) or Moll (sweat) glands

Question 18

What is the causation of external hordeolum?

Answer 18

same as internal: staph aureus, blockage/infection of Zeis (sebaceous) or Moll (sweat) glands

Question 19

What is the clinical presentation of chalazion?

Answer 19

hard, nontender swelling adjacent conjunctiva “painless, rubbery nodule”

Question 20

What is the treatment of chalazion?

Answer 20

warm compress
2-3 weeks and no improvement requires I&D and maybe a corticosteroid injection

NO ABX

Question 21

What is the clinical presentation of entropion?

Answer 21

inward turning of the lower eyelid

Question 22

What are the risks for entropion and ectropion?

Answer 22

elderly

Question 23

What is the causation of entropion?

Answer 23

loss of lid fascia, conjunctival scarring

Question 24

What is treatment for entropion?

Answer 24

Usually not much, but if lashes are scratching the cornea, surgery is required; maybe botox would help?

Question 25

What is the clinical presentation of ectropion?

Answer 25

outward turning of the lower eyelid

Question 26

What is the treatment of ecotropion?

Answer 26

keep eyes moist, surgery for excessive tearing, exposure keratitis or cosmetic issue

Question 27

What is the clinical presentation of dacryocystitis?

Answer 27

lacrimal SAC pain, unilateral swelling, tenderness, redness near sac area. Usually purulent; CHRONIC: tearing and discharge, mucus or pus may be expressed

Question 28

In who is dacryocystitis most common?

Answer 28

infants and >40 years old

Question 29

What is the causation of dacryocystitis?

Answer 29

acute: staph aureus chronic: staph epidermidis

Question 30

How do you treat dacryocystitis?

Answer 30

systemic oral abx with g+ coverage --> augmentin, cephs, cipro, clindamycin, bactrim Follow up! Chronic: keep latent with systemic, or relief of obstruction with surgery

Question 31

How do you manage a congenital nasolacrimal duct obstruction?

Answer 31

usually resolves spontaneously

Question 32

What is the clinical presentation for dacryadenitis?

Answer 32

lacrimal GLAND inflammation. Acute within hours or days with pain swelling, redness of outer portion of upper lid. Includes purulence, fever, malaise CHRONIC: bilateral, painless, soft tissue swelling

Question 33

What makes someone at risk for dacryadenitis?

Answer 33

inflammatory disorders

Question 34

What is the causation of dacryoadenitis?

Answer 34

acute is mostly viral -- EBV, mumps, coxsack, CMV, varicella bacterial -- staph aureus chronic--non-infectious inflammatory disorders (thyroid disease, sjorgen's, sarcoidosis)

Question 35

How do you diagnose dacryoadenitis?

Answer 35

culture and drainage (optional) chronic: requires lab workup for inflammatory etiology; biopsy

Question 36

What is the treatment of dacryoadenitis?

Answer 36

systemic abx -- oral cephalosporin (CEPHALEXIN) sulfameth-trimethoprim or linezolid for MRSA, IV or PO severe = IV naficillin or MRSA is IV vancomycin

Question 37

What is treatment for severe dacryoadenitis?

Answer 37

IV naficillin or for MRSA vancomycin IV

Question 38

What is the clinical presentation of dacryostenosis?

Answer 38

eyelash matting, tears that appear thicker and yellow in color

Question 39

What is the causation of dacryostenosis?

Answer 39

nasolacrimal duct obstruction

Question 40

What is the diagnosis process of dacryostenosis?

Answer 40

fluorescein applied to eye and left to check if cleared. Key=lack of accompanying symptoms

Question 41

how do you manage dacryostenosis?

Answer 41

supportive care --> gentle massage to drain duct

Question 42

how do you treat severe dacryoadenitis?

Answer 42

IV naficillin or MRSA-vancomycin

Question 43

What is posterior blepharitis associated with?

Answer 43

acne rosacea